| NPI | 1366604829 |
|---|---|
| Former Name | MIMI JOONYOUNG PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 056100-1) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 265566-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2016-02-25 |